Concurrent chemotherapy and radiotherapy with low-dose Cisplatin for nasopharyngeal carcinoma

Eighty-one patients with nondisseminated nasopharyngeal carcinoma consecutively treated between January 1977 and December 1998 were analyzed to evaluate whether a concurrent adjunction of low-dose cisplatin enhances the outcome of definitive radiotherapy. Ninety-eight percent (n = 79) of the cases were ranked as stage III/IV according to the 1987 Union International Contre le Cancer staging criteria. Patients treated before 1987 and treated after 1988 were mainly managed by radiotherapy alone (historical group: n = 48) and concurrent chemoradiotherapy with relatively low-dose cisplatin (CCRT group: n = 33), respectively. The locoregional failure-free survival rate of the CCRT group was significantly better than that of the historical group (72.8% vs. 35.9% at 5 years, p = 0.0041). However, multivariate analysis identified only the total dose and the T-stage as significant independent factors for locoregional control. No difference was observed on overall, disease-specific, and distant failure-free survival between the two groups. The results of the present study suggest that concurrent adjunction of low-dose cisplatin will not improve the outcome of definitive radiotherapy for nasopharyngeal carcinoma. Full-dose concurrent chemoradiotherapy, as well as the appropriate dose escalation for better locoregional control, will be mandatory to achieve better survival.